The Kawa River model was developed by Iwama in 2006 and was designed as a metaphor to be used in explaining the reasoning for aspects of occupational therapy intervention. It is designed to be a more culturally sensitive approach that is easily understood by a variety of patients due to its reliance on the example of a river. In this model, the river is a metaphor for life from birth to death, water is one’s energy or flow, rocks are negative circumstances in life that you must work around, driftwood is your personal assets and liabilities that can either assist you or get in your way depending on whether they clog up on the rocks or knock the rocks asside, and the walls and floor of the river are the social and physical environment and they impact the flow in the same way that the walls and floor of a real river impact its flow.

The Kawa model is applied to occupational therapy practice in six steps. Step one is to appreciate the client in their context. Step two is to clarify the context, identifying each component of the river metaphor and how it might be impacting flow. Step three is to prioritize the issues that are most important to the client. Step four is to assess the focal points of intervention by identifying what must be done with the previously identified issues in order to improve river flow. Step five is intervention, or acting upon the plans discussed in step four. And step six is evaluating the results.